Sacral Pressure Ulcers Research Articles

Utilization of osteopathic manipulation treatment in healing of pressure ulcers

Pressure ulcers (PUs), caused by prolonged pressure on the skin and tissue, affect millions annually in the US, resulting in significant emotional and financial burdens for patients. The healthcare system bears a substantial cost burden annually, primarily due to stage 3 and 4 ulcers. Through noninvasive techniques, osteopathic manipulative treatment (OMT) targets lymphatic system dysfunction and homeostasis to expedite patient recovery, with documented applications in conditions such as low back pain, pneumonia, and lower extremity wounds by optimizing lymphatic flow. However, the potential of OMT in managing PUs still needs to be thoroughly explored. This pilot study involved lymphatic OMT performed three times a week on patients admitted with community-or healthcare-acquired sacral PUs present for at least one week. Ulcer growth rates were calculated based on volume at baseline and in the third week following the first manipulation. Each patient was provided descriptive comparisons of albumin levels, body mass index (BMI), and demographic data, including age, sex, and race. At week three, following the initiation of treatment, decreased ulcer volume based on growth rate was observed in 75% of patients in our OMT group compared to 25% of patients in our control group. Our OMT pilot study suggests that adding OMT to standard therapy is safe and feasible, and it may accelerate the healing rate of sacral PUs while decreasing the cost burden on the healthcare system.

Evaluation of sacral pressure ulcers of older long-term hospital patients for five or fewer years

This study aimed to examine the statuses of sacral pressure ulcer and treatment strategies for 135 elderly patients who were long-term hospital patients. Patients with sacral pressure ulcers were divided into two groups, the cured or non-cured, and the discharged or deceased.The mean age, length of hospital stay, diagnosis, bedridden degree, nutritional status pre and post ulcer development, nutritional administration method, presence on admission or development, depth on National Pressure Ulcer Advisory Panel and treatment duration were examined.The serum albumin levels, lymphocyte counts and hemoglobin levels were calculated, and malnutrition levels were categorized into normal, mild, moderate or severe according to the Controlling Nutritional Status variant scores. The mean age of men (n=62) and women (n=73) was 80.8±4.9 and 86.2±1.2 years, and the mean length of hospital-stay was 25.1±9.6 and 27.3±4.9 months, respectively, indicating a significant difference.The diagnoses did not vary significantly between the cured (n=43) or non-cured (n=92) patients, or in those discharged (n=53) or deceased (n=82) patients.Comparison of the groups revealed that pressure ulcers were difficult to heal in patients with advanced age, those brought to hospital, bedridden degree C2 (unable to turn over), depth level III, moderate to severe malnutrition and those whose Gr did not improve.The effectiveness of gastrostomy management and the ineffectiveness of central venous nutrition were determined. Bedridden degree C2, depth level III, presence on admission, malnutrition on admission and no improvement were the factors for interruption of the healing.

Perioperative Nutritional Support Case Study for a Patient Undergoing Gluteus Maximus Flap Transfer Surgery for Pressure Ulcer

Pressure ulcers are caused by prolonged pressure on local tissues, leading to continuous ischemia, hypoxia, and malnutrition, resulting in tissue necrosis. Patients with pressure ulcers often experience varying degrees of malnutrition due to gut flora imbalance and a hypercatabolic state. This paper documents the case of a patient with a sacral pressure ulcer admitted to the Department of Burn and Plastic Surgery of the Affiliated Hospital of Qinghai University on November 28, 2023. Clinical nutrition treatment began on the second day of admission, including dietary guidance and enteral nutrition intervention. The patient's nutritional status gradually improved, leading to a successful recovery. By reviewing the nutritional treatment process and clinical outcomes, this case study provides valuable insights into the nutritional management of pressure ulcer patients.

Advanced wound healing with a three-dimensional matrix: interim results of a sacral pressure ulcer case study.

Advanced wound healing with a three-dimensional matrix: interim results of a sacral pressure ulcer case study.

Treatment of severe pressure ulcers with protein-enriched filtered platelet-rich plasma (PEFPRP): a possible management.

Background: Biological dressings with non-transfusion blood components are among the treatments available for pressure ulcers (PUs). Biological dressings contain active concentrated pro-regenerative molecules that can modify and switch off local inflammatory pathways. This re-establishes the physiological homing, which results in healing. In our study, we used a biological component obtained by ultrafiltration of plasma-platelet concentrate: protein-enriched filtered platelet-rich plasma (PEFPRP) with a higher platelet and higher plasma protein concentration. We tested whether treatment with PEFPRP could improve healing in advanced-stage pressure ulcers with a large surface area. All the patients in this study had a surgical indication but were not able to undergo surgery for various reasons. Materials and methods: Ten patients with severe neurological disability and advanced-stage sacral pressure ulcers were treated with allogenic PEFPRP. The mean lesion surface area at T0 was 13.4cm2 (±9.8 SD). PEFPRP was derived from allogenic plasma-platelet apheresis that had been pre-ultrafiltered with a ProSmart™ filter (Medica, Italy) to obtain a concentration after filtration of the plasma protein (12-16g/dL) and platelet (1-1.2 x 106 microL). Results and Conclusion: All cases showed a reduction in the surface area of the pressure ulcer and in the Pressure Ulcer Scale for Healing (PUSH) score. The mean reduction values at week 6 were as follows: -52% for surface area and -21% for PUSH. Rapid wound healing is fundamental to avoid infections and improve patients' quality of life. This blood component builds new tissue by creating a new extracellular matrix. This, in turn, promotes rapid restoration of the three-dimensional structure of the tissue necessary for healing deeper wounds. PEFPRP shrinks the PU and improves its morphological features (reducing undermining and boosting granulation tissue). PEFPRP also promotes tissue restoration, obtaining an optimal scar. It is a safe and feasible treatment, and these preliminary results support the use of PEFPRP in the treatment of pressure ulcers. PEFPRP dressings could be integrated in the standard treatment of advanced-stage PU.

The validity and safety of multispectral light emitting diode (LED) treatment on grade 2 pressure ulcer: Double-blinded, randomized controlled clinical trial.

The management of pressure ulcers (PUs) poses challenges due to their chronic nature and the lack of established conservative treatment methods. In this clinical trial, our objective was to examine the validity and safety of using a light-emitting diode device contained four wavelengths in the treatment of grade 2 sacral PUs. A total of 38 patients were randomly assigned to two groups: sham device (Sham) and experimental device (LED) group. The treatment sessions were conducted over a period of four weeks, with a frequency of three times per week. The study was conducted in a double-blinded manner. The study assessed the primary validity by measuring wound size and re-epithelialization after 0 and 4 weeks. Secondary evaluations included epidermal regeneration, collagen density, and immunological markers. Safety was evaluated by monitoring adverse reactions throughout the trial. The presence of eschar was found to have a significant impact on wound healing. Sham consisted of 15 wounds without eschar, while LED had nine. After treatment in without eschar situation, the post-treatment size of wounds in Sham was 13.80 ± 20.29%, while it was 3.52 ± 6.68% in LED. However, there was no significant difference (p = 0.070). And analysis of epidermal thickness showed a significant increase in LED (495.62 ± 327.09 μm) compared to Sham (195.36 ± 263.04 μm) (p < 0.0001). While LED treatment had a potential for wound reduction in PUs without eschar, we could not uncover evidence to support the efficacy of LED treatment in grade 2 PUs.

Thigh Abscess Formation Due to Severe Sacral Pressure Ulcer Dissemination: A Case Report

Patients with chronic and non-healing pressure ulcers are susceptible to recurrent infections, often leading to complications, such as abscesses. However, to the best of our knowledge, no cases of abscesses disseminating from a pressure sore to the thigh have yet been reported in the literature. We report the case of a 53-year-old man with a severe pressure ulcer in the sacral area and an abscess extending to the thigh. The presence of an abscess in an area devoid of pressure ulcers was suspected. Prior to surgical intervention, a comprehensive evaluation was undertaken, culminating in debridement and subsequent reconstruction, yielding excellent results. Abscesses are often difficult to evaluate with physical examination alone. Therefore, the possibility of extensive abscess formation and dissemination should be considered in patients with severe pressure ulcers.

The Use of Active Coagulation Whole Blood-An Innovative Treatment Strategy for Hard-To-Heal Wounds.

Deep and tunneling wounds are a challenge to apply and maintain most advanced wound dressings to promote effective healing. An autologous whole blood clot is a topical treatment and has been found to be safe and effective in healing cutaneous wounds. The active coagulation whole blood (ACWB) clot treatment, using the patient's own blood, is used to treat deep and tunneling wounds, by mixing the blood with coagulation components and applying it into the wound cavity allowing the clot to re-form inside the wound. We aimed to explore ACWB treatment in hard-to-heal wounds. 5 patients with multiple comorbidities, exhibiting surgical abdominal wound, chronic pilonidal sinus, stage 4 sacral pressure ulcer with exposed bone, post-amputation surgical site wound, and non-healing wound dehiscence at the site of a prior hip replacement, were all treated with the ACWB clot treatment. Complete wound healing was observed in 4/5 cases. In the fifth case, there was a 70% reduction in the depth and surface area of the abdominal surgical wound. The ACWB treatment was found to be effective in deep wounds with cavities and exposed structures. ACWB, in its flowable form, can effectively provide coverage of the deepest interstices of the wound's cavities by virtue of its liquid properties, forming a fibrin matrix, mimicking the role of the extracellular matrix. The flowable formulation of ACWB treatment safely and efficiently provides coverage of the entirety of the wound surface to improve the time and process of complex wound surface healing.

The biomechanical efficacy of a hybrid support surface in protecting supine patients from sacral pressure ulcers.

Support surfaces are the most important pressure ulcer/injury prevention technology available to clinicians for protecting their at-risk patients. A hybrid support surface marries the benefits of reactive and active support surfaces, by using high-quality foam material inside inflatable air cells. When used in its "static mode", it is a constant low air pressure mattress which delivers pressure redistribution in response to patient bodyweight and movements, by maximising the immersion and envelopment performance of the support surface. When used in its powered "dynamic mode", this system further delivers alternating pressure care via the connected foam and air cells. Modes of action of hybrid support surfaces were never studied quantitatively before, excluding through the limited scope of interface pressure mapping. In this work, we developed a novel computational modelling framework and simulations to visualise and quantify the state of soft tissue loading at the buttocks of a supine patient positioned on a hybrid support surface, in both the static and dynamic modes. We found that the dynamic mode effectively shifts deep concentrated soft tissue loading from under the sacral bone (towards the sacral promontory) to the tip of the sacrum (coccyx) and vice versa, and thereby, generates a deep tissue offloading effect.

Sacral Erector Spinae Plane Block As the Main Anesthetic Method for Parasacral Reconstructive Surgeries: A Single-Center Retrospective Cohort Feasibility Study.

Study objective Sacral erector spinae plane block (ESPB) is a regional anesthesia technique defined for the blockade of the posterior branches of the sacral nerves. In this study, we aimed to retrospectively evaluate our sacral ESPB applications as an anesthetic methodin patients who underwent parasacral and gluteal reconstructive surgery. Methodology The design of our study is a retrospectivecohortfeasibility study. This study was conducted at a tertiary university hospital, and patient files and electronic data systems were used to obtain data for analysis. In total, the data of 10 patients who underwentparasacral or gluteal reconstructive surgery were evaluated. Main results During reconstructive procedures for sacral pressure ulcers and lesions in the gluteal region, the sacral ESP block was utilized.Small doses of perioperative analgesics/anesthetics were required, but moderate or deep sedationor conversion to general anesthesia was not required. Conclusion Sacral ESP block is a viable regional anesthetic technique in reconstructive surgeries of the parasacral and gluteal regions.

Usefulness of leadless pacemaker implantation to continue chemotherapy for Burkitt's lymphoma without device infection despite repeated systemic infections.

Usefulness of leadless pacemaker implantation to continue chemotherapy for Burkitt's lymphoma without device infection despite repeated systemic infections.

Simple Diverting Colostomy for Sacral Pressure Ulcers: Not So Simple After All

BackgroundSurgeons are often asked to provide a diverting colostomy to enable healing or simplify management of sacral pressure ulcers. However, little evidence exists regarding the safety of a diversion in this often compromised patient population. We hypothesized that malnourished patients with sacral pressure ulcers have poor outcomes with fecal diversion. MethodsACS-NSQIP (2012–2018) was used to identify patients who underwent elective diverting colostomy for sacral pressure ulcers. Demographics, comorbidities, and perioperative details were recorded. Postoperative complications and 30-day mortality were compared between patients with moderate/severe hypoalbuminemia (< 2.5 g/dL) vs those with albumin > 2.5 g/dL. ResultsWe identified a total of 863 patients who underwent elective diverting colostomy for sacral pressure ulcer. Mean age was 57.5 years old. Rate of associated comorbidities was high, with most patients classified as ASA class 3 or 4. Over 40% of patients had a preoperative albumin level < 2.5 g/dL. Thirty-day overall postoperative mortality was 6.7%. This was significantly higher in patients with hypoalbuminemia (11.4% vs. 3.5%, p < 0.001). On multivariable regression analysis, preoperative albumin < 2.5 g/dL was independently associated with mortality (OR 1.92, p = 0.039). Other factors associated with mortality included increased age (OR 1.04 per year, p < 0.001), preoperative sepsis (OR 1.66, p = 0.003), and Black race (OR 2.2, p = 0.01). ConclusionsDiverting colostomy performed for patients with sacral pressure ulcers is associated with a substantial risk of postoperative death. Surgeons should carefully consider risks of diversion in this patient population, especially in malnourished patients with hypoalbuminemia.

Reconstructive surgery for treating pressure ulcers.

There are several possible interventions for managing pressure ulcers (sometimes referred to as pressure injuries), ranging from pressure-relieving measures, such as repositioning, to reconstructive surgery. The surgical approach is usually reserved for recalcitrant wounds (where the healing process has stalled, or the wound is not responding to treatment) or wounds with full-thickness skin loss and exposure of deeper structures such as muscle fascia or bone. Reconstructive surgery commonly involves wound debridement followed by filling the wound with new tissue. Whilst this is an accepted means of ulcer management, the benefits and harms of different surgical approaches, compared with each other or with non-surgical treatments, are unclear. This is an update of a Cochrane Review published in 2016. To assess the effects of different types of reconstructive surgery for treating pressure ulcers (category/stage II or above), compared with no surgery or alternative reconstructive surgical approaches, in any care setting. We used standard, extensive Cochrane search methods. The latest search date was January 2022. Published or unpublished randomised controlled trials (RCTs) that assessed reconstructive surgery in the treatment of pressure ulcers. Two review authors independently selected the studies, extracted study data, assessed the risk of bias and undertook GRADE assessments. We would have involved a third review author in case of disagreement. We identified one RCT conducted in a hospital setting in the USA. It enrolled 20 participants aged between 20 and 70 years with stage IV ischial or sacral pressure ulcers (involving full-thickness skin and tissue loss). The study compared two reconstructive techniques for stage IV pressure ulcers: conventional flap surgery and cone of pressure flap surgery, in which a large portion of the flap tip is de-epithelialised and deeply inset to obliterate dead space. There were no clear data for any of our outcomes, although we extracted some information on complete wound healing, wound dehiscence, pressure ulcer recurrence and wound infection. We graded the evidence for these outcomes as very low-certainty. The study provided no data for any other outcomes. Currently there is very little randomised evidence on the role of reconstructive surgery in pressure ulcer management, although it is considered a priority area. More rigorous and robust research is needed to explore this intervention.

Ischial and Sacral Pressure Ulcers

Background: Pressure ulcers remain a challenge for plastic surgeons to effectively manage because of the patient's underlying physical condition, weakness, risk factors associated with the diagnosis, and resultant insufficient wound healing that results in incomplete treatment or recurrence after surgery. This review describes and analyzes the current literature regarding the management of pressure ulcers.Methods: Risk factors primarily associated with wound dehiscence and recurrence were identified via a PubMed literature search using “ischial pressure ulcers, sacral pressure ulcers, and surgical coverage” as keywords. We analyzed and compared them to data from the Committee of the Japanese Society of Pressure Ulcers in 2016 and our facility.Results: Many published reports contain pedagogical comments on the successful management of pressure ulcers that remain significant. Some reported risk factors associated with flap dehiscence and ulcer recurrence are age, low serum albumin levels, previous operative failures at the same site, and ischial ulcers. The prevalence of deep pressure ulcers at the sacrum was more than three times higher than that at any other site. At our facility, the most frequently performed surgeries were for ischial ulcers, and 86% of pressure ulcers healed after surgery.Conclusions: Surgical site infection and surgical time were independent risk factors associated with wound dehiscence in the early phase after reconstruction. The effectiveness of closed wound management with negative-pressure wound therapy has been reported to be satisfactory for reconstructive surgeries with flaps for refractory pressure ulcers.

The impact of first wave of COVID-19 on the nursing-sensitive and rehabilitation outcomes of patients undergoing hip fracture surgery: a single centre retrospective cohort study

BackgroundDuring the COVID-19 pandemic, the care of hip fracture patients remains a clinical priority. To date, there is limited empirical knowledge about the impact of pandemic on the care of patients surgically treated for hip fracture, affected or not by COVID-19.ObjectiveTo investigate the effects of the COVID-19 pandemic on the nursing-sensitive and rehabilitation outcomes of frail patients undergoing hip fracture surgery.MethodsA retrospective cohort study was conducted in an Italian Orthopaedic Research Institute. All patients aged ≥ 65 years admitted with fragility hip fractures between 1st March and 30th June in 2019 (group PP: pre-pandemic) and in the same period in 2020 (group P: pandemic), were compared. In the P group, COVID-19 positive patients were excluded due to the presence of a specific treatment pathway. Data on patient demographics and baseline characteristics, and peri-operative care factors were obtained from the Institute’s computer-based patient-record system. The primary outcome was the incidence of any stage hospital-acquired pressure ulcers (PUs). The secondary outcome was time to first static verticalization and to first ambulation.ResultsThree-hundred and sixty patients were included in the study, which comprised 108 patients in PP group and 252 patients in P group. Overall PUs incidence was significantly higher in the P-group (21.8%) than in the PP-group (10.2%) (p = 0.009). Specifically, the incidence of sacral PUs was significantly lower in P-group (38.1%) vs PP-group (91%) (p = 0.004); on the contrary, the incidence of PUs localized to the heels or other body sites were significantly higher in P-group (30.9% and 30.9%, respectively) vs PP-group (0% and 9%, respectively) (p = 0.004).No significant between groups differences were found for all the secondary outcomes.ConclusionIn the pandemic period, nursing and rehabilitation care provided to patients with fragility hip fracture maintained high standards comparable to the pre-pandemic period. The increase in PUs incidence in the pandemic period was probably due to the older age of the patients admitted to hospital. The qualitative evaluation of the care administered and the emotional impact of the pandemic on the patients are very interesting topic which would deserve further investigation.

Sacral Pressure Ulcer Management by Negative Pressure Dressing: a Randomized Open Label Study

Sacral Pressure Ulcer Management by Negative Pressure Dressing: a Randomized Open Label Study

Novel Three-Dimensional Knitted Fabric for Pressure Ulcer Prevention: Preliminary Clinical Application and Testing in a Diabetic Mouse Model of Pressure Ulcers.

Background Population aging has led to an increased incidence of pressure ulcers, resulting in a social burden and economic costs. We developed a three-dimensional knitted fabric (3-DKF) with a pressure-reducing function that can be applied topically in the early stages of pressure ulcers to prevent progression. Methods We evaluated the effects of the 3-DKF in a streptozotocin-induced diabetes mellitus pressure ulcer mouse model, and the fabric was preliminarily applied to patients. Twelve-week-old male C57BL/6 mice were used for the animal experiments. In the pressure ulcer mouse model, an ischemia-reperfusion injury was created using a magnet on the dorsa of the mice. Pressure was measured with BodiTrak before and after applying the 3-DKF to 14 patients at risk of sacral pressure ulcers. Results In the 3-DKF-applied mice group, the ulcers were shallower and smaller than those in the control group. Compared with the mice in the control group, the 3-DKF group had lower platelet-derived growth factor-α and neutrophil elastase expression, as parameters related to inflammation, and increased levels of transforming growth factor (TGF)-β1, TGF-β3, proliferating cell nuclear antigen, and α-smooth muscle actin, which are related to growth factors and proliferation. Additionally, typical normal tissue staining patterns were observed in the 3-DKF group. In the preliminary clinical analysis, the average skin pressure was 26.2 mm Hg before applying the 3-DKF, but it decreased to an average of 23.4 mm Hg after 3-DKF application. Conclusion This study demonstrated that the newly developed 3-DKF was effective in preventing pressure ulcers through testing in a pressure ulcer animal model and preliminary clinical application.

Minimally invasive endoscopic approach to perform complete coccygectomy in patients with chronic refractory coccydynia: illustrative case.

BACKGROUNDCoccydynia refers to debilitating pain in the coccygeal region of the spine. Treatment strategies range from conservative measures (e.g., ergonomic adaptations, physical therapy, nerve block injections) to partial or complete removal of the coccyx (coccygectomy). Because the surgical intervention is situated in a high-pressure location close to the anus, a possible complication is the formation of sacral pressure ulcers and infection at the incision site.OBSERVATIONSIn this case report, the authors presented a minimally invasive, fully endoscopic approach to safely perform complete coccygectomy for treatment of refractory posttraumatic coccydynia.LESSONSAlthough this is a single case report, the authors hope that this novel endoscopic approach may achieve improved wound healing, reduced infection rates, and lower risk of penetration injury to retroperitoneal organs in patients requiring coccygectomy.

Effectiveness of a multi-layer silicone-adhesive polyurethane foam dressing as prevention for sacral pressure ulcers in at-risk in-patients: Randomized controlled trial

BackgroundThere is need for improvement in effective pressure ulcers preventive strategies. ObjectiveTo study whether a multi-layer silicone-adhesive polyurethane foam dressing shaped for the sacrum prevents PUs development in addition to standard PU preventive care for at-risk hospitalized patients. DesignOpen-label, parallel group, multi-center randomized controlled trial. Participants and setting709 in-hospital patients at risk for pressure ulcers from 25 medical, surgical, and intensive care units of 12 Italian hospitals. MethodsA multi-layer silicone-adhesive polyurethane foam was applied to the sacrum in addition to standard PUs preventive care in the intervention group. In the control group, standard preventive care alone, including systematic pressure ulcer risk assessment, skin assessment three times per day, routine positioning every 4 h, use of active support surface as appropriate, and incontinence skin care, was guaranteed. Primary outcome was incidence of sacral pressure ulcers of any stage at seven days from hospital admission. Secondary outcomes were incidence of sacral pressure ulcers ≥ II stage, number of days needed to PU development, number of skin adverse events due to the foam dressing, number of dressings used for each patient, number of withdrawing patients due to discomfort caused by the foam dressing. Participants were evaluated at baseline and at seven days. ResultsIn patients admitted to medical units, 15/113 controls and 4/118 in the intervention group developed sacral pressure ulcers (p = 0.010; absolute reduction 9.2%; NNT for benefit 11, 95% CI 6 to 44). In patients admitted to surgical units, 21/144 controls and 8/142 in the intervention group developed sacral pressure ulcers (p = 0.010; absolute reduction 8.9%; NNT for benefit 11 95% CI 6 to 49). Pressure ulcers incidence was not significantly different between the randomization arms (5.2% experimental vs 10.4% control, p = 0.141) in patients admitted to intensive care units. Overall, 46/358 (12.8%) controls and 17/351 (4.8%) in the intervention group developed sacral pressure ulcers (p<0.001; absolute reduction 8%; number needed to treat (NNT) for benefit 12, 95% CI 8 to 26). Incidence of sacral pressure ulcers ≥ II stage did not differ significantly between the two groups. No adverse skin reactions and discomfort attributable to the foam application were reported. ConclusionA sacral multi-layer silicone-adhesive polyurethane foam in addition to standard preventive care is effective for pressure ulcers prevention in at-risk hospitalized patients admitted to medical and surgical units.TRIAL REGISTRATION: ClinicalTrials.gov NCT03900455. The registration (April 1st, 2019) occurred before the first patient was enrolled (October 21st, 2019).

Usefulness and Our Ingenuity of a Perforator-preserving Gluteal Artery-based Rotation Fasciocutaneous Flap for Sacral Pressure Ulcers

Usefulness and Our Ingenuity of a Perforator-preserving Gluteal Artery-based Rotation Fasciocutaneous Flap for Sacral Pressure Ulcers